Mat White and Deb Cracknell have coordinated the fourth paper in the VNP’s Demystifying Series: ‘Demystifying Health Metrics’. The paper aims to unpack quantitative measures of health & wellbeing to demonstrate the value of the natural environment for human health & wellbeing for the natural capital community. Members of the team worked on a previous paper demystifying the concept of ‘Health’.
The paper is structured around five key issues:
- Rapid review of relevant quantitative metrics;
- Motivations for measuring health;
- Identifying/developing a theory of change to inform metric choices;
- Factors to consider when choosing quantitative health metrics; and
- Factors to consider when collecting, analysing and communicating quantitative health metrics/outcomes.
What are health metrics?
“Health metrics are measures of health determinants, states, or outcomes. They may relate to general health status, (healthy-) life expectancy, disease (communicable or non-communicable), fitness, function and/or capacity (including mental/cognitive capacity and physical disability), injury, or death. They can cover both acute (short-term) states such as negative mood or temporary back pain, and chronic (long-term or recurring) conditions such as depression or chronic back pain. Health related metrics usually refer not to the health states themselves but to health determinants or risk factors, such as diet, physical activity, smoking, environmental pollution or unsafe work environments. Health metrics typically relate to either incidence, the rate of new cases of the health outcome, or prevalence, the proportion of ‘cases’ in the population during a specific period of time (period prevalence) or on a given date (point prevalence). Health metrics can be used at an individual, community or population level.
Health metrics are used for many different purposes including:
- Monitoring population health and inequalities in
- Tracking extent or progression of disease
- Assessing the efficacy of health interventions
- Valuing different health promotion or care options
- Targeting health investment and activity
Some health metrics enable comparisons across different health states (e.g. Disability Adjusted Life Years [DALYs] and Quality Adjusted Life Years [QALYs]) and, with caution, can be translated into economic values to support decision making. Individual health metrics can also be brought together to create tools such as the Global Burden of Disease which is used to ‘quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated’. ”
Who’s it for?
The paper is written for the natural capital community most involved in commissioning, conducting and interpreting other’s investigations into the links between natural environments and health, but who do not have extensive formal training in research approaches in this area. Third-sector environmental organisations, national park managers, local authority teams and some central government agency staff (e.g. Natural England) are all examples of our target audience. Although the issues discussed are global we focus primarily on the UK setting.
In addition to the paper we have provided a number of additional resources:
- A table of health metrics used in a nature-based context;
- A table of health metrics from other non-environment and health contexts;
- A health metrics reference list of recent reviews of health and environment linkages with associated commentary on usage.
How was it developed?
The report draws on ideas and feedback from participants at two expert stakeholder workshops (London/Leeds, June 2019) and iterative consultation with the wider VNP community, including responses to earlier drafts of this document:
Drs. Deborah Cracknell, Rebecca Lovell, Benedict Wheeler and Mathew White at the European Centre for Environment & Human Heath, University of Exeter.
Key consultants throughout the process:
Val Woods and Dr. Sunita Sarkar at the Centre for Ecology and Hydrology, and Dr. Ruth Garside, Prof. Lora Fleming and Prof. Ian Bateman at the University of Exeter.
Contributors who helped set the agenda and commented on earlier drafts included:
London/Leeds workshop attendees:
Jim Burt, Natural England
Alison Darlow, Natural England
Dr. Nicola Dempsey, University of Sheffield
Dr. Eirini Flouri, University College London
Prof. Marc Jones, Manchester Metropolitan University
Dr. Rosie McEachan, NHS/Born in Bradford
Dr. Amy Mizen, Swansea University
Dr. Liz O’Brien, Forest Research
Rebecca Robertson, University of Leeds
Prof. Sarah Rodgers, University of Liverpool
Dr. Mike Rogerson, University of Essex
Prof. Catherine Ward Thompson, University of Edinburgh
Dr. Sue Williams, Natural Resources Wales
Dr. Cheryl Willis, Natural England
On-line survey contributors:
Lauriane Suyin Chalmin-Pui, University of Sheffield
Dr Cláudia Costa, University of Coimbra
Dr Mike Gent, Public Health England
Angela Hands, Public Health England
Mikaël J.A. Maes, University College London
Dr Jean McKendree, Stockholm Environmental Institute
Jim Stewart-Evans, Public Health England
Jim Wharfe, Independent Consultant